Department of Cardiac Surgery, City Hospital of Zurich - Triemli, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2022 Jul 11;62(2). doi: 10.1093/ejcts/ezac328.
Concerns exist about higher rates of pacemaker implantation using the extended superior transseptal approach for mitral valve surgery. This study aims to compare the extended superior transseptal and the left atrial approach regarding the need for pacemaker implantation after mitral valve surgery.
We performed a retrospective analysis of the data of patients undergoing mitral valve surgery through either a sternotomy and transseptal approach or a mini-thoracotomy and left atrial approach in a single centre in the period January 2010 to May 2021. The primary outcome was the evaluation of the postoperative pacemaker implantation rate.
Overall, 677 patients were included, 333 with transseptal and 344 with left atrial approach, and 58 (8.6%) patients underwent pacemaker implantation postoperatively. There was no significant difference in the rate of pacemaker implantation between the 2 groups [overall: 34 (10.2%) vs 24 (7%), P = 0.133; for sinus node dysfunction: 12 (3.6%) vs 9 (2.6%), P = 0.459; for high-degree atrioventricular block: 22 (6.6%) vs 15 (4.4%), P = 0.199; transseptal vs left atrial approach, respectively]. A subgroup analysis of the relative effect of transseptal versus left atrial approach on the rate of postoperative pacemaker implantation revealed mitral replacement as a statistically significant confounder (P = 0.019). The exclusion of patients undergoing concomitant cardiac procedures did not lead to a statistically significant difference in the pacemaker implantation rate between the 2 approaches.
The analysis of the data of these patients shows no significant difference in the rate of permanent pacemaker implantation between the extended superior transseptal and the left atrial approach for mitral valve surgery.
对于二尖瓣手术中使用扩展的上房间隔入路，人们对更高的起搏器植入率存在担忧。本研究旨在比较扩展的上房间隔入路和左心房入路在二尖瓣手术后需要植入起搏器的情况。
我们对 2010 年 1 月至 2021 年 5 月在单一中心接受经胸骨切开术和房间隔入路或小开胸术和左心房入路的二尖瓣手术患者的数据进行了回顾性分析。主要结局是评估术后起搏器植入率。
共有 677 例患者入组，其中 333 例行房间隔入路，344 例行左心房入路，58 例（8.6%）术后行起搏器植入。两组之间的起搏器植入率没有显著差异[总体：34（10.2%）比 24（7%），P=0.133；窦性心动过缓：12（3.6%）比 9（2.6%），P=0.459；高度房室传导阻滞：22（6.6%）比 15（4.4%），P=0.199；分别为房间隔入路和左心房入路]。对房间隔入路与左心房入路对术后起搏器植入率的相对影响进行亚组分析显示，二尖瓣置换术是一个具有统计学意义的混杂因素（P=0.019）。排除同时进行心脏手术的患者后，两种入路之间的起搏器植入率没有统计学差异。
对这些患者数据的分析表明，二尖瓣手术中使用扩展的上房间隔入路和左心房入路在永久性起搏器植入率方面没有显著差异。
